Emergency department syndromic surveillance systems: a systematic review

Abstract

Background Syndromic surveillance provides public health intelligence to aid in early warning and monitoring of public health impacts (e.g. seasonal influenza), or reassurance when an impact has not occurred. Using information collected during routine patient care, syndromic surveillance can be based on signs/symptoms/preliminary diagnoses. This approach makes syndromic surveillance much timelier than surveillance requiring laboratory confirmed diagnoses. The provision of healthcare services and patient access to them varies globally. However, emergency departments (EDs) exist worldwide, providing unscheduled urgent care to people in acute need. This provision of care makes ED syndromic surveillance (EDSyS) a potentially valuable tool for public health surveillance internationally. The objective of this study was to identify and describe the key characteristics of EDSyS systems that have been established and used globally. Methods We systematically reviewed studies published in peer review journals and presented at International Society of Infectious Disease Surveillance conferences (up to and including 2017) to identify EDSyS systems which have been created and used for public health purposes. Search criteria developed to identify “emergency department” and “syndromic surveillance” were applied to NICE healthcare, Global Health and Scopus databases. Results In total, 559 studies were identified as eligible for inclusion in the review, comprising 136 journal articles and 423 conference abstracts/papers. From these studies we identified 115 EDSyS systems in 15 different countries/territories across North America, Europe, Asia and Australasia. Systems ranged from local surveillance based on a single ED, to comprehensive national systems. National EDSyS systems were identified in 8 countries/territories: 2 reported inclusion of ≥85% of ED visits nationally (France and Taiwan). Conclusions EDSyS provides a valuable tool for the identification and monitoring of trends in severe illness. Technological advances, particularly in the emergency care patient record, have enabled the evolution of EDSyS over time. EDSyS reporting has become closer to ‘real-time’, with automated, secure electronic extraction and analysis possible on a daily, or more frequent basis. The dissemination of methods employed and evidence of successful application to public health practice should be encouraged to support learning from best practice, enabling future improvement, harmonisation and collaboration between systems in future. Prospero number CRD42017069150.

Lessons from COVID-19 syndromic surveillance through emergency department activity: a prospective time series study from western Switzerland

“… 5 However, only one-third of European countries include ED data in their syndromic surveillance. 6 Until now, this has not been the case in Switzerland where ED data sets have not been used to detect or monitor epidemic outbreaks and, more specifically, the COVID-19 outbreak.…”

Development and assessment of a hospital admissions-based syndromic surveillance system for COVID-19 in Ontario, Canada: ACES Pandemic Tracker

“…The importance of public health surveillance systems to monitor the spread and impact of disease within the population has been well demonstrated during the COVID-19 pandemic [ 3 – 6 ]. Public health surveillance systems have the capability to serve as early warning systems and provide situational awareness during public health emergencies, including communicable disease outbreaks, natural disasters and bioterrorism, among others [ 7 , 8 ]. Information from public health surveillance systems can also provide scientific evidence essential to public health decision-making and control measures.…”

“…Information from public health surveillance systems can also provide scientific evidence essential to public health decision-making and control measures. Additionally, public health surveillance can guide health-related policy development, including disease prevention and risk mitigation strategies, and contribute to epidemiologic understanding of various communicable and non-communicable diseases [ 7 , 8 ].…”

“…Data sources for large scale regional SyS systems often include health or pseudo-health information from healthcare services such as emergency department (ED) [ 10 , 11 ] or primary care visits [ 12 – 14 ], but could also include information from retail pharmaceutical sales [ 15 , 16 ], emergency medical services dispatch data [ 17 – 21 ], telehealth phone lines [ 22 , 23 ] and non-health information from social media [ 6 , 24 ]. The indirect nature of health-related indicators, although nonspecific [ 25 ], have the ability to improve timeliness and sensitivity of data collection and provide flexibility to adapt to different illnesses and situations [ 7 , 26 ].…”

Using routine emergency department data for syndromic surveillance of acute respiratory illness in Germany, week 10-2017 to 10-2021

“…Syndromic surveillance using routine emergency department data can be a fast approach to report and detect changes in healthcare utilization, without creating an additional administrative burden. In the United Kingdom (9), France (10) and other countries, syndromic surveillance systems based on emergency department data have been established (11, 12), and have previously provided timely public health insight at extraordinary times such as extreme weather events (13) or mass gatherings (e.g. the Olympic Games in 2012 (14)), as well as during the COVID-19 pandemic (15).…”